Gender differences in Nutritional Status, Food consumption and Oxidative Stress in Post-Stroke patients during Rehabilitation

Abstract

Abstract Objectives This study aimed to clarify the gender differences in nutritional status, food consumption and oxidative stress and in post-stroke patients during rehabilitation treatment. Design A longitudinal observational study. Methods Patients with first stroke were sequentially enrolled, evaluated at admission (T0), and again after a 6-week rehabilitation program (T1). The rehabilitation regimen included traditional and robotic physical therapy. Functional independence in Activity of Daily Living (ADL) was evaluated with modified Barthel Index assesment (mBI T0 and mBI T1) and calculating its change after rehabilitation (∆BI= mBIT1- mBI T0). Patients were screened for malnutrition at admission, following the GLIM criteria, by the Mini Nutritional Assessment Short-form (MNA-SF®) and the assessment of the nutritional status during the study was performed by means of: i) anthropometric measurements ii) the Geriatric Nutritional Risk assessment (GNRI), and iii) daily estimation of food consumption (plate waste). An Analysis of blood parameters at T0 and at T1 was performed including: albumin, glucose, lipidic panel, calcium, magnesium and iron. Systemic Oxidative stress status was evaluated at T0 and at T1 measuring: hydroperoxides (dROMs), total antioxidants (BAP), thiols (-SHp) and calculating the antioxidant capacity (OSI index). Results We finally included 87 patients in this study (42 women, 45 men mean age 69 ± 12 years). The sample was homogeneous and the whole group was at highly risk of malnutrition at admission with 44 subjects clearly malnurished (score lower than 7). Women wasted 23% of total plate consumed respect to 17% wasted from men. Hydroperoxides levels were very high in the whole groupat T0 and T1, but men after rehabilitation had lower values of dROMs, while women did not. Men reached higher value of mBI T1 respect to women (67.1 ± 21.9 vs 55.3 ±26.1; p = 0.032), moreover only 36% of women ameliorated their mBI of at least ten point, respect to 64% of men. MNA-SF® correlated with mBI T0, mBI T1 and ∆BI, but in women this correlation was higher [mBI T0 (rho = 0.506 p<0.001); with mBI T1 (rho = 0.527; p<0.001); with ∆BI (rho = 0.394; p = 0.001)], suggesting a relationship between their nutritional status at admission and their performance in functional recovery. Conclusions. Among subacute post stroke patients hospitalized for rehabilitation treatment, women appeared to have lower rehabilitation outcome, to waste more food and to have higher oxidative stress even after six-week of hospitalization. So, especially in consideration of the advanced age, women should be carefully monitored forn nutritional status during hospitalization for rehabilitation; future studies should clarify if a better nutrition, which includes the right dose of antioxidants, can improve their recovery after stroke.